Check out the fine print on most prescription or over-the-counter drug inserts, and it's likely you'll read why you shouldn't pop any of those pills without calling your doctor if you're pregnant or breastfeeding. How carefully do you need to follow those warnings? If you're expecting, you need to be extremely careful about the meds you take. But when you're breastfeeding, do the same restrictions apply?
While you still need to pay attention to what goes into your body when you're nursing, the truth is that most medications — both over-the-counter (OTC) and prescription — don't affect the quantity of milk a breastfeeding mom makes or the wellbeing of her baby. Indeed, most medications are compatible with breastfeeding, and for those few medications that are a safety issue, there are usually acceptable substitutions.[1]
Not convinced that you can probably continue nursing even though you have to take some medication? While it's true that what goes into your body usually does make its way into your milk supply, keep in mind that the amount that ultimately ends up in your baby's meals is a tiny fraction of what gets to you.
Most drugs, in typical doses, appear to have no effect on a nursing baby at all. Others have a mild, temporary effect, and a very few can be significantly harmful.
But since not enough is known about the long-term effects of medications on breastfeeding babies, it's best to play it safe when it comes to taking over-the-counter or prescription drugs while you're breastfeeding. Avoid any medication unless it's been prescribed to you by a doctor, dentist or other health care provider who knows you're nursing, or is from a list of safe OTC meds (which again, most are).
How to tell if a medication is safe for breastfeeding
In June 2015, the Food and Drug Administration (FDA) started requiring prescription drug manufacturers to meet new labeling standards that offer more up-to-date and detailed information specific to lactating moms.[2]
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Under the rules, drug-makers must disclose the amount of the drug that ends up in breast milk and any potential side effects on breastfed babies, along with details on any human and animal studies that have been done and any adverse reactions in breastfeeding women. This information will help you and your health care provider better understand the risks versus the benefits of taking medication while you're breastfeeding.
In the meantime, just about every OTC and prescription medication simply carries a warning (on the label, package or both) to consult a doctor before taking it if you're nursing. That means your best source of information is your baby's pediatrician or your own doctor.
He or she can give you the short list of common medications that are breastfeeding compatible (and that you can take as needed without getting clearance each time), as well as advice on whether medications or supplements you've been prescribed or take regularly (say, for a chronic condition) need to be adjusted until you wean your little one.
Medications that are considered safe for breastfeeding
The most recent research indicates that most medications can be used safely during breastfeeding. These include (but are not limited to):
- Acetaminophen (Tylenol)
- Antacids (Maalox, Mylanta, Tums)
- Anticoagulants (blood thinners such as Lovenox, Fragmin, Innohep, Heparin)
- Antihistamines (such as Claritin; Benadryl is also safe but may cause infant drowsiness)
- Corticosteroids (Prednisone)
- Decongestants (Afrin, Allegra and so on), but not those containing pseudoephedrine, which can decrease milk supply
- Histamine H2 blockers/proton-pump inhibitors for acid reflux and heartburn (Zantac, Pepcid AC, Prilosec)
- Ibuprofen (Advil, Motrin)
- Laxatives (Metamucil, Colace)
- Progestin-only birth control (the pill and injections)
- Most antibiotics
- Most anti-yeast/fungal medications (Lotrimin, Mycelex, Diflucan, Monistat)
- Most antidepressants. Talk to your health care provider; if you're already taking one, there's a good chance he or she will recommend continuing to do so but maybe at a different dosage.
- Most medications for chronic conditions, such as for asthma, heart conditions, thyroid disease, high blood pressure and diabetes)
- Most sedatives
- Some anxiety medications (Ativan, Serax)
Medications to avoid while breastfeeding
Some medications, however, are clearly harmful. These include (but are not limited to):
- Cancer drugs
- Certain epilepsy and seizure drugs
- Ergots (used to treat migraines)
- Some beta blockers (used to treat irregular heartbeat and high blood pressure)
And some medications should be avoided because they can reduce your milk supply, including (but not limited to):
- Pseudoephedrine, an antihistamine (Sudafed)
The jury is still out on other medications — certain classes of antihistamines, for instance, or some antidepressants (although most are safe and treating postpartum depression may improve milk supply). And other medications are safe, but only if they're used sparingly and temporarily, such as narcotics for pain after a cesarean delivery, for instance. (Take only one tablet every six to eight hours maximum and watch for drowsiness in the baby.) Be sure to check with your baby's pediatrician for the most up-to-date info on what is and isn't safe.
In some cases, a less-safe medication can safely be discontinued while a mom is breastfeeding, and in others, it's possible to find a safer substitute. When medication that isn't compatible with breastfeeding is needed short-term, nursing can be stopped temporarily (with breasts pumped and milk tossed — i.e. "pump and dump").
You can also time the dosing for just after nursing or before your baby's longest sleep period (after you put her to bed for the night). As always, only take medicines — and that includes herbals and supplements — with your practitioner's approval.
You can also check out the National Library of Medicine's Drug and Lactation database (LactMed) or the Infant Risk Center for more information on which medications are safe and which aren't when you're breastfeeding your little one.
And if you do start a new doctor-approved medication, keep an eye on your baby for any unusual changes such as fussiness, rash or a change in eating or sleeping habits. If you do notice anything, it never hurts to give your health care provider a heads up.
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